Individual
MS. JUANETTA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
8057 WILLIARD RD, BASTROP, LA 71220-8939
(318) 556-0043
(318) 556-3633
Mailing address
PO BOX 561, 8057 WILLARD ROAD, BASTROP, LA 71221-0561
(318) 556-0043
(318) 556-3633
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
900889
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1171506
—
LA
05
—
1564761
—
LA
Enumeration date
01/04/2007
Last updated
07/09/2007
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